EP 44. Treatment perspectives using deep brain stimulation in patients with Parkinson’s Disease in the Republic of Moldova

Abstract

Given the large number of patients with Parkinson’s Disease (PD), high rate of failure of modern medical treatment and the lack of this method of treatment in Republic of Moldova at present, we proposed to analyse the treatment perspectives using Deep Brain Stimulation (DBS) in patients with PD and determine candidates for it based on the patients database of the national Institute of Neurology and Neurosurgery. The study of immediate and long-term results of treatment with DBS-therapy in patients with Parkinson’s Disease based on specialised publication from the last 20 years. The second objective is the statistical analysis of available data of PD patients admitted in the Institute of Neurology and Neurosurgery during 2012–2013 years. The third objective is to determine potential candidates for DBS based on our Institute database of patients with Parkinson’s Disease. in accordance with internationally accepted criteria and guidelines. And the last objective is to estimate the costs of implementation of such type of treatment in practice. The study included analysis of 130 records of patients with PD admitted to the national Institute of Neurology and Neurosurgery (INN) during the period of 2012–2013 years. Forty-four articles published consecutively during the 1994–2015 years containing information about criteria used for DBS-patients selection were taken from PubMed database (US National Library of Medicine – National Institutes of Health) and served for authors as a support in the process of determining future perspectives of this method in the treatment of patients with PD in the Republic of Moldova. The performed clinical analysis of 130 consecutive PD referrals showed that 24 patients (18.46%) can be considered candidates for DBS treatment. This group of patients shows the next additional data: mean age 59.5 years, 11 (45.8%) were men and 13 (54.2%) – women. Mean disease duration was 6.8 years; the average Hoehn and Yahr stage was 2.3 points. The disease manifested as tremorigen form in 22 (91.6%) cases and only 1 patient (4.1%) manifested dyskinesia. One patient from this group already underwent a neurosurgical intervention -thalamotomy. Main reasons for exclusions were: secondary Parkinsonism cases (60%), negative levodopa test (60% of patients), comorbidities (35% of cases), changes on MRI/CT (61% of patients) and cognitive disorders (26% of cases). At least 24 patients selected from a number of 130 consecutive PD patient’s cases could benefit using DBS-therapy. Same studies, related to patients selection, showed a result of 40% (Coleman et al., 2014, Moro et al., 2009). This significantly difference, in our opinion, is caused by the high rate of comorbidities, which was the main reason for hospitalisation, whereas the majority of patients are supervised outside of hospitals by family doctors. We consider strongly necessary to introduce DBS-treatment in the Republic of Moldova by creating one special national program with international support.